老年颈动脉狭窄患者颈动脉内膜剥脱术后发生无症状性脑梗死的相关因素

Related factors for silent brain infarction in elderly patients with carotid artery stenosis after carotid endarterectomy

目的探讨老年颈动脉狭窄患者颈动脉内膜剥脱术(carotid endarterectomy,CEA)术后发生无症状性脑梗死(silent brain infarction,SBI)的危险因素。方法选取2020年4月至2023年4月河北医科大学附属衡水市人民医院神经外科收治的行CEA治疗的老年颈动脉狭窄患者216例,根据术后30 d是否发生SBI分为SBI组39例和非SBI组177例。筛选影响老年颈动脉狭窄患者CEA后发生SBI的危险因素。基于危险因素构建老年颈动脉狭窄患者CEA后发生SBI预测模型,对预测模型进行验证和预测效能评估。结果SBI组颈动脉重度狭窄、非强回声斑块、颈动脉易损性斑块比例、同型半胱氨酸(homocysteine,Hcy)、三酰甘油(triacylglycerol,TG)水平明显高于非SBI组(P<0.05)。颈动脉重度狭窄、非强回声斑块、颈动脉易损性斑块、Hcy≥13.81μmol/L、TG≥4.76 mmol/L是影响老年颈动脉狭窄患者CEA后发生SBI的危险因素(P<0.05)。危险因素构建模型预测CEA后SBI发生的ROC曲线下面积、敏感性、特异性分别为0.871(95%CI:0.715~0.939)、94.50%、76.30%。结论颈动脉重度狭窄、非强回声斑块、颈动脉易损性斑块、Hcy≥13.81μmol/L、TG≥4.76 mmol/L均是影响CEA后发生SBI的危险因素。基于上述危险因素构建预测模型对老年颈动脉狭窄患者CEA后发生SBI具有较高的预测价值。

Objective To explore the risk factors for SBI after CEA in elderly patients with CS.Methods A total of 216 elderly CS patients undergoing CEA in our department from April 2020 to April 2023 were divided into SBI group(39 cases)and non-SBI group(177 cases)according to the occurrence of SBI in 30 d after surgery or not.The risk factors for SBI after CEA in elderly CS patients were screened out,and then a prediction model of SBI was constructed based on these risk factors.The prediction model was validated and its prediction efficacy was evaluated.Results Significantly larger proportions of severe CS,non-hyperechoic plaque and vulnerable carotid plaque,and higher levels of Hcy and TG were observed in the SBI group than the non-SBI group(P<0.05).The severe carotid stenosis,non-hyperechoic plaque,vulnerable carotid artery plaque,Hcy≥13.81μmol/L,and TG≥4.76 mmol/L were all risk factors for SBI after CEA in elderly CS patients(P<0.05).The AUC value,sensitivity and specificity of the constructed model was 0.871(95%CI:0.715-0.939),94.50%and 76.30%respectively.Conclusion Severe carotid artery stenosis,non-hyperechoic plaque,vulnerable carotid artery plaque,Hcy≥13.81μmol/L and TG≥4.76 mmol/L are all risk factors for SBI after CEA.The prediction model based on the above risk factors has high predictive value for the occurrence of SBI after CEA in elderly CS patients.